San Francisco Goes Against the Grain in Nursing Home Plan
San Francisco plans to spend about $600 million to replace the Laguna Honda Hospital and Rehabilitation Center, an effort that "bucks a tenuous trend across the country" to provide care to seniors in their homes or in assisted living facilities, the Wall Street Journal reports.
"A debate has long raged over whether it's cheaper to care for the elderly and frail in institutions or at home," and the federal government "now believes it can save Medicaid dollars and improve elderly people's lives by encouraging more home care," the Journal reports.
However, nursing homes "still are favored by federal Medicaid payment rules, which in recent years have allowed the elderly and younger disabled to seek alternatives but require them to clear more hurdles to qualify," according to the Journal.
According to the Journal, Laguna Honda "benefits from unusually friendly treatment from Medicaid," under which reimbursements are doubled to $338 per patient daily because the facility is licensed as both a hospital and a nursing home, although the facility has only 20 hospital beds. With additional payments from the city, Laguna Honda receives an average of $431 per patient daily, and the new facility could receive as much as $500 per patient daily because of additional payments from Medicaid and the city related to construction costs.
"While San Francisco has its own roster of home and community programs for the elderly," critics maintain that the "new Laguna Honda's existence will push residents into it who otherwise could be in more homey settings" and that the cost of the new facility "will starve other alternatives of funds," according to the Journal.
However, Sen. Dianne Feinstein (D-Calif.) and House Speaker Nancy Pelosi (D-Calif.) support the new facility.
Pelosi said, "Sure, it would be nice if you could reinvent the wheel. But I am more interested in seeing that very sick people have skilled nursing care and access to a physician 24 hours a day" (Lagnado, Wall Street Journal, 5/7).